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Sometimes a client will be come aware during or just after a session of feeling worse than they did before. They came because they wanted to feel better, so what’s going on? Is the therapy working?

Often during our lives we build coping strategies, ways that help us get through the day the best we can, in the moment. Let’s say you tend to internalise things. These strategies might include holding your tongue when someone is out of order, because overall it seems easier not to fight. You might feel that a situation is unfair then reason with yourself that compared to someone with real problems you have nothing to complain about. It is natural to avoid and defend against feeling or expressing these negative emotions and bottle them up. You don’t want to bother others with your ‘stuff’. If anyone asks, you’re “fine”. Until one day you’re not.

In therapy, you have a safe, confidential space to own, express and explore your true feelings. As a therapist, I genuinely care about the pain, its causes and how it impacts your life. When the pain is no longer ignored or minimised, you start to feel it. You might be stretched out of your comfort zone. So it is possible (but not essential) that therapy can hurt as you start to change and build resilience. The pain can be part of the transition towards healing and growth.

It is also important to work out if your therapist is the right one for you. Therapy should be a non-judgemental, safe place and your therapist must be appropriately qualified, empathic and able to explain why they think a particular approach might be suitable for you. Check out your therapist’s credentials, ask them questions, challenge them. Your recovery is paramount; it’s your choice and your right to decide if you would like to continue. Any therapist worth their salt would welcome that discussion.

Week two of 2018, the Christmas lights have been packed away and the weather here today is grey and frankly a bit miserable. Meanwhile on Facebook and Instagram people are smiling with their perfect teeth, posing with their perfect children, maybe in their perfect homes. The continual visual input from this and advertising can create pressure and unrealistic expectations within ourselves. (I’d quite like this blog to have the wit and startling insight of an award-winning novel.) It can be tempting to compare and despair. We want to be perfect, like the pictures, but fear we might never get there. We start criticising ourselves, saying things like, “What’s the point? I’ll never be Wonderwoman – or Superman.”

In the weight management groups I’ve run we talk about how to counteract this negative self-talk. I ask clients to look in the mirror first thing in the morning every day and say one positive thing about themselves. For many this was the hardest thing about the whole course. To help, I had stickers with sayings like ‘You rock!’ or ‘Ace!’ or ‘Top Bananas!’ The clients took away a sticker they liked, put it on the mirror and then each morning would read it out first thing. ‘You rock!’ is a much nicer way to start the day than ‘Ugh’.

So why not try being kind to yourself first thing. Forget about donning the cape and the red pants and the red suspenders – just between us, they were never your best look anyway. And totally impractical for winter. Focus instead on being good enough; you already are – I really believe that. In fact, you rock.

Sometimes I will meet someone whose main problem is exhaustion. They put everyone else first – they don’t even come second or third on the list. They’re the one who gets the late night call for a lift because it’s raining. They bake the cakes for the fundraiser when they’ve already done a full day’s work. They give, give, give and can’t make time to recharge their own batteries. They want to say no, but struggle to do it. If this sounds familiar, here are 5 ways to stop that pattern.

When someone asks you a favour, imagine a big red ‘STOP’ sign flashing in front of your eyes. Try that now. It doesn’t mean you have to say no to everything, but it will give you the chance to pause and consider what’s best.

Say no with empathy. If someone’s in a tricky situation, say ‘That sounds really difficult but I don’t have the time to give right now.’ People like to be heard and understood and this is a way of saying no with respect.

Know that your needs count. You don’t have to apologise when you’re not able to be there, especially when it comes out of the blue. Track how often you say sorry to people and make it a personal goal to reduce the number of times a week you apologise unnecessarily.

Know your boundaries. Set yourself a schedule of when you can be available each week and then stick to it. For example, if you have a friend who’s constantly calling with their problems, you could say, “This isn’t a good time right now, but let’s agree a time that suits us both later in the week.” Then set a limit on that time.

Reward yourself when you’ve done any of the above. Recognise your own worth and your achievements. Celebrate the victories and enjoy the change. You just got yourself some you-time. Enjoy.

Have you ever worried how someone would react if you told them what was really going on in your head? Those niggling thoughts, the scathing self-judgement if you make a mistake? ‘Idiot.’ ‘Told you it was useless.’ If a friend spoke to you like that you’d drop them, wouldn’t you?

As a therapist I often get to hear about those thoughts. (Actually, I ask about them. That’s therapists for you.) Clients tell me that often it’s not so much the initial problem that bothers them; it’s the mental fall out, the shame spiral afterwards that can cause the most pain. And they’ve never spoken about it before.

It’s important to know that this inner chatter is learned. You’re not born with it (babies don’t have it). And the great news is because it was learned, it can be unlearned. The therapy room is a safe place to bring these dark thoughts into the open. You can use techniques to manage or get rid of the chatter. You can find out where it came from in the first place and let go. You can free yourself.

But one thing’s for certain – you’re not stupid. It takes courage to open up to someone else in this way. It’s a real privilege for me to hear about it. And personally I respect you for that.